<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Level_text')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-level_text" class="form-control" name="row[level_text]" type="text" value="{$row.level_text|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Level_icon')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-level_icon" class="form-control" size="50" name="row[level_icon]" type="text" value="{$row.level_icon|htmlentities}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-level_icon" class="btn btn-danger faupload" data-input-id="c-level_icon" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-level_icon"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-level_icon" class="btn btn-primary fachoose" data-input-id="c-level_icon" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-level_icon"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-level_icon"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Level_content')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-level_content" class="form-control editor" rows="5" name="row[level_content]" cols="50">{$row.level_content|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Totaldistance')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-totaldistance" class="form-control" step="0.01" name="row[totaldistance]" type="number" value="{$row.totaldistance|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
